Predicting risk factors likely to cause early recurrence following laparoscopic ventral/IHR

Nehemiah Samuel, Mr, Fayyaz A Mazari, Mr, Muhammad H Shiwani, Mr. Barnsley Hospital NHS Foundation Trust

AIM: To assess our experience in laparoscopic repair of ventral and incisional hernias (LRVIH) and predict risk factors likely to cause recurrence over early follow-up period.

METHODS: Prospective single centre study of consecutive LRVIH performed by one Consultant Surgeon over last 4 years. Patient demographics, periprocedural details, recurrence at follow-up were all recorded. Hernias were classified according to Europen Hernia Society (EHS) classification. Univariate and Multivariate analysis were performed to associate risk factors with hernia recurrence.

RESULTS: 90 patients M:F 42:48; mean (SD) age 56.5(13.9) years; BMI of 32 (6.1) kg/m2; Smokers 22 (24.4%); ASA: 2 (60%), 3 (13.3%), 4 (1.1%) underwent repairs for 19 (21.1%) primary ventral hernias, 61 (67.8%) incisional hernias and 10 (11.1%) recurrent-incisional hernias. The median (i.q.r.) defect size was 25 (12-108) cm2; with EHS classified width: W1=26.7%,  W2=45%, W3=24.4%; 16 patients had complications: 8 (8.8%) seromas, 1 (1.1%) haematoma, 4 (4.4%) respiratory complications; 3 (3.3%) conversions to open and 1 (1.1%) re-operation for small bowel obstruction. There were 5 (5.5%) recurrences over 1-year follow-up period. There were no significant predictors of recurrence on univariate logistic regression for risk factors of Gender, Age, BMI, Smoking status, ASA, Type of hernia, Width and Type of Mesh. However controlling for the above factors, multivariate regression demonstrated the width of the defect as a significant predictor for recurrence OR (95%CI) 6.20 (1.12-34.33) P=0.037

CONCLUSIONS: LRVIH is safe and effective with low early recurrence rates. It can be offered to the elderly, obese patients, and those with significant comorbidities without increased risk of early recurrence. Wider defects carry a higher risk of recurrence with LRVIH, however the risk is comparable to recurrence with open repairs and carries the significant advantage of low morbidity and early recovery.

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